Finally can use HgbA1c to Diagnose Diabetes




Finally, the American Diabetes Association and a few international diabetes organizations have agreed to allow the use of HgbA1c to diagnose diabetes.

HgbA1c is a better test since, wide swings don’t affect it, you don’t have to go on an 8 hour hunger strike, acute illness or current administration of steroids doesn’t affect it, much more stable and standardized test.

What if you have sickle cell disease and have an abnormally high HgbA1c? You can use the old method of a fasting glucose, or get a fructosamine test (which gives you a two week average).

Before 1997, you had to do an oral glucose tolerance test to be considered “diabetic”. In 1997, they changed the guidelines and all you needed was a fasting glucose over 126 (why they chose such a high number I don’t know, should be 100).

Of course, after the 1997 change to a fasting glucose of 126, a lot more people who were previously “not diabetic” suddenly became “diabetic”. Which is good and bad. On the bright side, you now know you have a serious issue and need to address it. On the bad side, it probably shocked some people.

The committee has already decided that they will allow HgbA1c to be used, the question is where will the number be set? Is it going to be 6.5? Or 5.5?

At 6.5%, you are diabetic. Normal people (who are not diabetic) never have a HgA1c over 6%. In fact, most non-diabetics run in the low 5s.

If you set the number at 5.5%, you have a whole host of people now that will be considered diabetic that previously were told “you are borderline diabetic”. This is great, because finally doctors will start treating these people early.

Hopefully, this new standard will spur physicians to start treating diabetics sooner and sooner with metformin (for type 2 diabetics) and delay the complete failure of the pancreas for as long as possible.

The problem in type 2 diabetics (90% of all diabetics) is insulin resistance. Your cells are resistant to insulin, so your pancreas make more of it, to overcome the resistance. Metfromin sensitizes your cells to insulin and allows your cells to use your insulin more appropriately and your pancreas can take a break and not have to make so much. Hence, saving your pancreas!

I am interested in seeing what level they set this at. Of course, smart doctors know that unless your HgA1c is less than 6 (and usually a lot less), you have a problem, and should be on metformin.

The American Diabetic Association already has a calculator on their website that translates fasting sugars to HgA1c values: http://professional.diabetes.org/GlucoseCalculator.aspx

As well as other resources: http://professional.diabetes.org/ResourcesForProfessionals.aspx?cid=60378&typ=17